Universidade de São Paulo
Biblioteca Digital da Produção Intelectual - BDPI
Departamento de Psiquiatria - FM/MPS
Artigos e Materiais de Revistas Científicas - FM/MPS
2009
Cognitive restructuring for compulsive buying
Revista Brasileira de Psiquiatria, v.31, n.1, p.77-78, 2009
http://producao.usp.br/handle/BDPI/10145
Downloaded from: Biblioteca Digital da Produção Intelectual - BDPI, Universidade de São Paulo
Cartas aos Editores 77
Cognitive restructuring for
compulsive buying
Reestruturação cognitiva para compras
compulsivas
30
25
20
15
Dear Editor,
Compulsive buying (CB), or Oniomania (from the Greek:
oné – shopping, mania – frenzy), is characterized by excessive
preoccupations and desire to purchase objects, and unrestrained
shopping to the point of personal suffering and financial hardship1.
The criteria proposed by McElroy2 are the most used until nowadays,
since both DSM and ICD have not proposed operational criteria for
this syndrome, which is classified as an impulse control disorder
not otherwise specified. If CB was officially recognized, it would
become the most common impulse control disorder, with prevalence
estimates ranging from 2 to 8% of the adult population1.
Cognitive behavioral therapy (CBT) has shown promising results
for CB with significant decrease of shopping time and episodes
compared to a waiting-list3. However, this and other CBT programs
for CB do not encompass, or at least have no described cognitive
restructuring techniques aiming at cognitive distortions specific to
shopping behavior. Keeping this in mind, we developed a CBT
program for CB aiming at identifying and changing cognitive
patterns that influence shopping behavior, raising awareness of
high risk situations. Table 1 summarizes the content of the 20
weekly group sessions. Sessions 6, 7 and 8 are dedicated to
cognitions most commonly related to shopping among compulsive
buyers: shopping as a way of coping with emotions, shopping as
a way of building an identity, and “all or nothing” type of thinking
applied to shopping1.
The purpose of this communication is to report the outcome of
our pilot CBT group with an emphasis on cognitive restructuring for
CB. The group consisted of nine individuals, only one male, mean
age of 41.8 years-old, only three married, all meeting McElroy’s
criteria for CB. Psychiatric comorbidity was assessed by the Mini
International Neuropsychiatric Interview (MINI)4. Seven out of
10
5
0
Pct 01
Pct 02
Pct 03
Pct 04 Pct 05 Pct 06
1a Session
20o Session
Pct 07
Pct 08
the nine participants presented a current depression, and two of
them met criteria for bipolar disorder, but their loss of control over
shopping was not better explained by their mood disorders, since
shopping bouts also occurred during periods of euthymia.
Participants answered the Yale-Brown Obsessive-Compulsive
Scale-Shopping Version (YBOCS-SV)5, at the beginning and at
the end of treatment. The YBOCS-SV is a 10-item scale; the first
five questions are added up to produce a cognitive score (COG),
and the last five ones produce a behavioral score (BEH). COG and
BEH scores can be added to produce one last total score (TOT).
TOT varies from 0 to 40, indicating the severity of the shopping
psychopathology.
We used Wilcoxon Signed Ranks tests to compare pre and
post-treatment scores. COG (pre-treatment median/post-treatment
median = 12/6, Z = -2.68, p = 0.007), BEH (10/6, Z = -2.67,
p = 0.008) and TOT (22/11, Z = -2.67, p = 0.008) significantly
decreased after CBT treatment – see Figure 1.
The conclusion is that group therapy with an emphasis on
detection of specific shopping cognitive distortion and restructuring
may help compulsive buyers in dealing with both cognition and
shopping behavior. Controlled studies are warranted in order to
determine the generalizability of the present findings and to
compare different approaches to this troublesome, and yet poorly
recognized disorder.
Tatiana Zambrano Filomensky, Hermano Tavares
Impulse Control Disorders Outpatient Unit, Institute
and Department of Psychiatry, Universidade de São Paulo (USP),
São Paulo (SP), Brazil
Rev Bras Psiquiatr. 2009;31(1):76-81
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78 Cartas aos Editores
Disclosures
Writting group
member
Employment
Research
grant1
Other research grant or
medical continuous
education2
Speaker’s
honoraria
Ownership
interest
Consultant/
Advisory
board
Other3
Tatiana Zambrano
Filomensky
USP
---
---
---
---
---
---
Hermano Tavares
USP*
ANJOTI*
FAPESP**
---
Janssen-Cilag*
Instituto Américo
Bairral
---
---
Lundbeck*
Servier*
Roche*
Apsen*
Wyeth*
Sandoz*
Abbott*
Cristália
Editora Artes Médicas
TAM Linhas Aéreas
* Modest
** Significant
*** Significant. Amounts given to the author's institution or to a colleague for research in which the author has participation, not directly to the author.
Note: USP = Universidade de São Paulo; FAPESP = Fundação de Amparo a Pesquisa de São Paulo; ANJOTI = Associação Nacional do Jogo Patológico e Outros
Transtornos do Impulso.
For more information, see Instructions for authors.
References
1.
Tavares H, Lobo DS, Fuentes D, Black DW. Compulsive buying
disorder: a review and a case vignette. Rev Bras Psiquiatr.
2008;30(Suppl 1):S16-23.
2. McElroy SL, Keck PE Jr., Pope HG Jr., Smith JM, Strakowsiki
SM. Compulsive buying: a report of 20 cases. J Clin Psychiatry.
1994;55(6):242-8.
3. Mitchell JE, Burgard M, Faber R, Corsby RD, de Zwaan M. Cognitive
behavioral therapy for compulsive buying disorder. Behav Res Ther.
2006;44(12):1859-65.
4. Amorim P. Mini International Neuropsychiatric Interview (MINI):
validation of a short structured diagnostic psychiatric interview. Rev
Bras Psiquiatr. 2000;22(3):106-15.
5. Monahan P, Black DW, Gabel J. Reliability and validity of a scale to
measure change in persons with compulsive buying. Psychiatry Res.
1996;64(1):59-67.
Internet addiction: a case report
Dependência de internet: um relato de caso
Brought in for refusing treatment, he showed dysphoric mood,
grandiose ideation, logorrhea, compromised pragmatism, and no
critical sense about his condition.
By applying CY-BOCS, concerns about contamination, excessive
hand washing, ritualized toilet, nose-cleaning compulsion, and
clothing checking (consuming 2 hours a day) were revealed,
although there was no critical sense about them.
During hospitalization, bipolar disorder (BD), attention-deficit/
hyperactivity disorder (ADHD) with predominance of inattentiveness,
obsessive-compulsive symptoms, simple phobia, and impulse
control disorder, NOS (IA) were hypothesized. He had previous
family history of alcohol and drug abuse, BD, and depression.
F. was discharged after 14 days, showing mood stabilization
with divalproate sodium 750 mg/day and partial critical sense
about his problem. Outpatient treatment was indicated. We cannot
report the progression of Internet use-related behavior following
hospitalization because the patient dropped out treatment.
Many adolescents are difficult to treat and highly resistant to
treatment, once the Internet is disseminated in this age group as
a habit incorporated to school life and social relationships (e.g.,
Orkut). The Web has become an anonymity and comfort zone,
where the delay in communication favors the creation of better
forms of self-expression, such as the possibility of creating new
personal characteristics. Thus, for individuals having social anxiety
or low self-esteem the perspective of manipulating reality turns the
Internet addiction (IA) is the lack of ability to control Internet
use and involvement leading to progressive loss of control. With
negative social effects, Internet addicts use the Web as a social and
communication tool, once they experience higher levels of pleasure
and satisfaction when online than in real life1.
We report the case of F., 15, from Sao Paulo, an only child who had
been confined at home for 2 years for being online (average, 12-18
hrs/day, maximum, 38 hrs uninterruptedly). In addition to excessively
worrying about the Internet (Criterion #1), he also showed a constant
need for increasing online time (Criterion #2) and eventually lost
control over use (Criterion # 3). With his parents split, he stopped
going to school for 2 years (Criterion #6) and would not leave his
room, where he got online. The Internet gave him relief by providing
an escape from his life problems (Criterion #8). Irritated when his
mother unplugged the computer (Criterion # 4), he physically attacked
her three times. In the past, showing depression, he was hospitalized
due to his aggressiveness after oral administration of fluoxetine.
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